Case reports: Iatrogenic bronchial rupture following the use of endotracheal tube introducers Compte rendu de cas: rupture bronchique iatrogène après utilisation d’introducteurs de tubes endotrachéaux

Purpose Endotracheal tube introducers are often used in difficult tracheal intubations, but they are rarely deemed responsible for airway injuries. There have been only a few reports of severe complications, such as pharyngeal perforation, mainstem bronchus bleeding, perforation of the tracheal mucosa, and tracheal abrasion associated with hemopneumothorax. Using a computed tomography (CT) scan, we illustrate two cases of non-severe airway injuries related to endotracheal tube introducers. Clinical features We present two cases of distal bronchial lacerations caused by introducers. The first occurrence was caused by a Muallem ET Tube Stylet (METTS) in a patient who underwent surgery for a total thyroidectomy and presented hemoptysis at suction after tracheal intubation. The second occurrence was caused by an Eschmann Tracheal Tube Introducer (gum elastic bougie) in a patient whose trachea was intubated before a radiofrequency ablation of a single lung metastasis. There was evidence of blood on the tip of the bougie after withdrawal. In both cases, a CT scan showed a post-traumatic bronchial laceration with an acquired bronchial ectasia surrounded by ground-glass opacity due to alveolar hemorrhage. The patients had no other clinical complications, and bronchial lesions resolved spontaneously at control CT scan. Conclusion These two cases show that airway damage related to endotracheal tube introducers may not be exceptional. It is not unusual to have some blood on an airway management device, and the rate and severity of these lesions are unknown. However, damage to the airway can be avoided by adapting preventive techniques during tracheal intubation. Résumé Objectif Les introducteurs de tubes endotrachéaux sont souvent utilisés dans les cas d’intubation trachéale difficile, mais ils sont rarement jugés responsables de blessures des voies aériennes. Il n’y a eu que quelques cas rapportés de complications sévères, telles qu’une perforation pharyngée, une hémorragie dans une bronche souche, la perforation de la muqueuse trachéale, et une abrasion trachéale associée à un hémopneumothorax. À l’aide de la tomodensitométrie thoracique (TDM), nous illustrons deux cas de lésions non-graves des voies aériennes liées à des introducteurs de tubes endotrachéaux. Caractéristiques cliniques Nous présentons deux cas de lacérations bronchiques distales provoquées par les introducteurs. Le premier cas a été causé par un Muallem ET Tube Stylet (METTS) chez un patient qui subissait une chirurgie pour thyroı̈dectomie totale et qui a présenté une hémoptysie à l’aspiration après l’intubation trachéale. Le deuxième cas a été provoqué par un introducteur de tube Author contributions Mehmet Sahin and Gilbert R. Ferretti were involved in manuscript preparation and manuscript conception and design. Mehmet Sahin, Daniel Anglade, Martine Buchberger, Pierre Albaladejo, and Gilbert R. Ferretti were involved in the acquisition of data. Mehmet Sahin, Adrien Jankowski, Pierre Albaladejo, and Gilbert R. Ferretti were involved in the analysis and interpretation of data. Adrien Jankowski Pierre Albaladejo, and Gilbert R. Ferretti were involved in drafting the article and revising it critically for important intellectual content. Gilbert R. Ferretti was involved in the final approval of the version to be published. M. Sahin, MD A. Jankowski, MD G. R. Ferretti, MD, PhD (&) Clinique Universitaire de Radiologie et Imagerie Médicale, CHU Grenoble, Université J Fourier, 38043 Grenoble Cedex, France e-mail: [email protected] D. Anglade, MD, PhD M. Buchberger, MD P. Albaladejo, MD, PhD Department of Anesthesiology, CHU Grenoble, Grenoble Cedex, France 123 Can J Anesth/J Can Anesth (2012) 59:963–967 DOI 10.1007/s12630-012-9763-z